不同类型新型冠状病毒肺炎患者凝血功能特征及其临床意义  

Characteristics of coagulation function in patients with different types of coronavirus disease 2019 and its clinical significance

作　　者：秦志均 刘磊 李怡 杨曦 李霞[1] 刘家盛[3] 罗建飞[3] 刘丹[4] QIN Zhijun;LIU Lei;LI Yi;YANG Xi;LI Xia;LIU Jiasheng;LUO Jianfei;LIU Dan(Dept,of Intensive Care Unit,Sichuan Provincial Orthopedic Hospital,Chengdu 610041,Sichuan,China;Dept,of Infection Management,Sichuan Provincial Orthopedic Hospital,Chengdu 610041,Sichuan,China;Dept,of Gastrointestinal Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept,of Respiratory and Critical Care Medicine,West China Hospital of Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川省骨科医院重症医学科,四川成都610041 [2]四川省骨科医院医院感染管理科,四川成都610041 [3]武汉大学人民医院胃肠外科,湖北武汉430060 [4]四川大学华西医院呼吸与危重症医学科,四川成都610041

出　　处：《武汉大学学报（医学版）》2021年第1期19-22,71,共5页Medical Journal of Wuhan University

基　　金：国家重点研发计划项目(编号:2017YFC0910004)。

摘　　要：目的:分析不同类型新型冠状病毒肺炎(简称新冠肺炎)患者的凝血功能相关指标,探讨新冠肺炎患者的凝血功能特征及其临床意义。方法:回顾性分析2020年2月2日至2020年3月25日在武汉大学人民医院东院出院/死亡的新冠肺炎患者111例,根据病情危重程度及临床结局分为普通型组(A组,36例)、重症存活组(B组,35例)、重症死亡组(C组,40例),将患者一般临床资料及凝血相关指标行描述性分析并进行组间比较。结果:111例患者凝血酶原时间(PT)、凝血酶时间(TT)增高比例分别为24.3%、7.2%;活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、抗凝血酶Ⅲ(AT-Ⅲ)和血小板(PLT)增高占比分别为25.2%、59.5%、0.9%和16.2%,降低占比分别为10%、5.4%、36%和14.4%;D-二聚体(D-D)和纤维蛋白/纤维蛋白原降解产物(FDP)分别为0.95(0.49,5.24)mg/L和3.57(1.51,16.86)mg/L。除APTT以外,PT、TT、FIB、AT-Ⅲ和PLT三组间构成比均有显著统计学差异(P<0.05)。C组患者中PT、TT增高,FIB、AT-Ⅲ、PLT降低比例均显著高于A组和B组,D-D、FDP在A、B、C三组间呈现"阶梯式"增高,差异均有统计学意义(P<0.05)。结论:新冠肺炎患者机体凝血功能紊乱发生比例较高,且符合弥散性血管内凝血(DIC)病理生理特征,随着病情严重程度增加,可能出现DIC进程加剧并引发不良临床结局。Objective:To investigate the characteristics and clinical significance of coagulation function in coronavirus disease 2019(COVID-19) patients.Methods:A total of 111 discharged/dead patients with COVID-19 were collected and analyzed from East Hospital of Renmin Hospital of Wuhan University from February 2 to March 25,2020.These patients were divided into general group(group A,36 cases),severe survival group(group B,35 cases),and severe death group(group C,40 cases).Patient’s general clinical data and coagulation-related indicators were descriptively analyzed and compared.Results:Among the 111 patients,the proportions of increased prothrombin time(PT) and thrombin time(TT) were 24.3% and 7.2%,respectively;the proportions of increased activated partial thromboplastin time(APTT),fibrinogen(FIB),and antithrombin Ⅲ(AT-Ⅲ) and platelet(PLT)were 25.2%,59.5%,0.9%,and 16.2%,respectively,and decreased proportions were 10%,5.4%,36%,and 14.4%;D-dimer(D-D) and fibrin/fibrinogen degradation products(FDP) were0.95(0.49,5.24) mg/L and 3.57(1.51,16.86) mg/L,respectively.Except for APTT,the composition ratios of PT,TT,FIB,AT-Ⅲ and PLT in the three groups were significantly different(P<0.05).In group C,the proportions of increased PT and TT and decreased FIB,AT-Ⅲ,and PLT were significantly higher than those in groups A and B(P<0.05).D-D and FDP showed a "stepwise"increase among the three groups(P<0.05).Conclusion:The incidence of coagulation disorders is higher in patients with COVID-19 and is consistent with the pathophysiology of DIC,as the disease gets worse,the deterioration of DIC may occur and lead to adverse clinical outcomes.

关 键 词：新型冠状病毒肺炎 凝血功能 弥散性血管内凝血 

分 类 号：R512.99[医药卫生—内科学]